Keywords
Stroke
Thrombolytic Therapy
Aged, 80 and over
Risk Factors
Prognosis
Thrombolytic Therapy
Aged, 80 and over
Risk Factors
Prognosis
How to Cite
Bayona-Ortíz, H., Díaz-Cruz, C. A., Góez-Mogollón, L., Useche-Gómez, N., Valencia-Mendoza, M. C., López, V. J., & Díaz-Campos, A. (2017). Observational study of thrombolytic treatment for acute stroke in patients older and younger than 80 years: experience from one hospital in Bogotá, Colombia, 2007-2014. Médicas UIS, 30(3), 21–30. https://doi.org/10.18273/revmed.v30n3-2017002
Abstract
Background: we depict the experience with the use of thrombolysis for acute ischemic stroke in a tertiary center in South America. Objective: to describe the main outcomes in our population of patients aged less and older than 80 years treated with recombinant tissue plasminogen activator. Materials and Methods: retrospective observational study. We described the main variables and the difference in outcome accounting for age. Results: 70 patients were included. 51.4% of the patients were women, 22.8% were older than 80 years. The average window time was 70 minutes and the average door-to-needle time was 90 minutes. Hypertension, dyslipidemia and previous stroke were the most common risk factors. Favorable outcome Modified Rankin Scale ≤2 was present in 25% of the patients older than 80 years and 53.7% in the population younger than 80 years (p=0.009). Mortality was present in 31.2% of the patients older than 80 years and in 5.5% of the patients younger than 80 years (p=0.005). Symptomatic intra-cerebral hemorrhage was found in 6.25% of the patients older than 80 years (p=0.65), compared to 3.7% in the younger than 80 years. Conclusions: we found that intravenous thrombolysis still had benefit in people older than 80 years. Significant differences in symptomatic intra-cerebral hemorrhage were not found, however, a greater mortality in patients older than 80 years was. These findings of our experience of recombinant tissue plasminogen activator use in real life are consistent with other latinamerican publications. MÉD.UIS. 2017;30(3):21-30.
References
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3. World Health Organization [Internet]. Global burden of stroke [Citado 2016 Dic 18]. Disponible en: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf?ua=1].
4. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355-69.
5. Feigin VL, Mensah GA, Norrving B, Murray CJ, Roth GA. Atlas of the Global Burden of Stroke (1990-2013): The GBD 2013 Study. Neuroepidemiology. 2015;45(3):230-6.
6. Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 2009;8(4):345-54.
7. Saposnik G, Cote R, Phillips S, Gubitz G, Bayer N, Minuk J, et al. Stroke outcome in those over 80: a multicenter cohort study across Canada. Stroke. 2008;39(8):2310-7.
8. DANE [internet]. Population and Demography - Projected Populations. [Citado 2017 Ene 30]. Available from: http://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-ypoblacion/proyecciones-de-poblacion.
9. Van der Worp HB, van Gijn J. Clinical practice. Acute ischemic stroke. N Engl J Med. 2007;357(6):572-9.
10. Lo EH, Dalkara T, Moskowitz MA. Mechanisms, challenges and opportunities in stroke. Nat Rev Neurosci. 2003;4(5):399-415.
11. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6(2):182-7.
12. Del Zoppo GJ. Plasminogen activators and ischemic stroke: conditions for acute delivery. Semin Thromb Hemost. 2013;39(4):406-25.
13. The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group. Tissue Plasminogen Activator for Acute Ischemic Stroke. New Engl J Med. 1995;333(24):1581-8.
14. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Thrombolysis with Alteplase 3 to 4.5 hours after Acute Ischemic Stroke. N Engl J Med. 2008;359(13):1317-29.
15. Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.
16. Coutts SB, Wein TH, Lindsay MP, Buck B, Cote R, Ellis P, et al; Heart, and Stroke Foundation Canada Canadian Stroke Best Practices Advisory Committee. Canadian Stroke Best Practice Recommendations: secondary prevention of stroke guidelines, update 2014. Int J Stroke. 2015;10(3):282-91.
17. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al; American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641.
18. European Stroke Organisation. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457-507.
19. Lindsay P, Bayley M, Hellings C, Hill M, Woodbury E, Phillips S. Canadian best practice recommendations for stroke care (updated 2008). CMAJ. 2008;179(12 Suppl):S1-25.
20. Colombian General Social Security System for Health. Clinical Practice Guideline for diagnosis, treatment and rehabilitation of Acute Ischemic Stroke in population over the age of 18. 2015.
21. Adams HJ, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41.
22. Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in StrokeMonitoring Study (SITS-MOST): an observational study. Lancet. 2007;369(9558):275-82.
23. Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA. Gender Differences in Stroke Incidence and Poststroke Disability in the Framingham Heart Study. Stroke. 2009;40(4):1032-7.
24. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke: Results From a Population-based Study. Stroke. 2005;36(6):1115-9.
25. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545-88.
26. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and metaanalysis. Lancet. 2012;379(9834):2364-72.
27. van Oostenbrugge RJ, Hupperts RM, Lodder J. Thrombolysis for acute stroke with special emphasis on the very old: experience from a single Dutch centre. J Neurol Neurosurg Psychiatry. 2006;77(3):375-7.
28. Tanne D, Gorman MJ, Bates VE, Kasner SE, Scott P, Verro P, et al. Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older : the tPA stroke survey experience. Stroke. 2000;31(2):370-5.
29. Uyttenboogaart M, Schrijvers EM, Vroomen PC, De Keyser J, Luijckx GJ. Routine thrombolysis with intravenous tissue plasminogen activator in acute ischaemic stroke patients aged 80 years or older: a single centre experience. Age and ageing. 2007;36(5):577-9.
30. Boulouis G, Dumont F, Cordonnier C, Bodenant M, Leys D, Henon H. Intravenous thrombolysis for acute cerebral ischaemia in old stroke patients >/= 80 years of age. J Neurol. 2012;259(7):1461-7.
31. Gomez-Choco M, Obach V, Urra X, Amaro S, Cervera A, Vargas M, et al. The response to IV rt-PA in very old stroke patients. Eur J Neurol. 2008;15(3):253-6.
32. Toni D, Lorenzano S, Agnelli G, Guidetti D, Orlandi G, Semplicini A, et al. Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy. Cerebrovasc Dis. 2008;25(1-2):129-35.
33. Berrouschot J, Rother J, Glahn J, Kucinski T, Fiehler J, Thomalla G. Outcome and severe hemorrhagic complications of intravenous thrombolysis with tissue plasminogen activator in very old (> or =80 years) stroke patients. Stroke. 2005;36(11):2421-5.
34. Chen CI, Iguchi Y, Grotta JC, Garami Z, Uchino K, Shaltoni H, et al. Intravenous TPA for very old stroke patients. Eur Neurol. 2005;54(3):140-4.
35. Ringleb PA, Schwark C, Kohrmann M, Kulkens S, Juttler E, Hacke W, et al. Thrombolytic therapy for acute ischaemic stroke in octogenarians: selection by magnetic resonance imaging improves safety but does not improve outcome. J Neurol Neurosurg Psychiatry. 2007;78(7):690-3.
36. Sylaja PN, Cote R, Buchan AM, Hill MD. Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study. J Neurol Neurosurg Psychiatry. 2006;77(7):826-9.
37. Meseguer E, Labreuche J, Olivot JM, Abboud H, Lavallee PC, Simon O, et al. Determinants of outcome and safety of intravenous rt-PA therapy in the very old: a clinical registry study and systematic review. Age Ageing. 2008;37(1):107-11.
38. Mouradian MS, Senthilselvan A, Jickling G, McCombe JA, Emery DJ, Dean N, et al. Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients. J Neurol Neurosurg Psychiatry. 2005;76(9):1234-7.
39. Saposnik G, Baibergenova A, O’Donnell M, Hill MD, Kapral MK, Hachinski V, et al. Hospital volume and stroke outcome: Does it matter?. Neurology. 2007;69(11):1142-51.
40. Castañeda Cardona C, Coral Casas J, Rueda MC, Díaz Cortés D, Ruíz A. Experience with intravenous thrombolysis for stroke in the Hospital Universitario San Ignacio 2011-2013 (EXTRO HUSI). Acta Neurol Colomb. 2014;30(1):16-21.
41. Tosta ED, Rebello LC, Almeida SS, Neiva MS. Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil. Arq Neuropsiquiatr. 2014;72(5):368-72.
42. Cabral NL, Conforto A, Magalhaes PS, Longo AL, Moro CH, Appel H, et al. Intravenous rtPA versus mechanical thrombectomy in acute ischemic stroke: A historical cohort in Joinville, Brazil. eNeurologicalSci. 2016;5:1-6.
43. Arora R, Salamon E, Katz JM, Cox M, Saver JL, Bhatt DL, et al. Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age. Stroke. 2016;47:2347-54.
44. Adeoye O, Hornung R, Khatri P, Kleindorfer D. Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years. Stroke. 2011;42(7):1952-5.
45. Heo JH, Kim YD, Nam HS, Hong K-s, Ahn SH, Cho HJ, et al. A Computerized In-Hospital Alert System for Thrombolysis in Acute Stroke. Stroke. 2010;41:1978-83.
2. Wechsler LR. Intravenous Thrombolytic Therapy for Acute Ischemic Stroke. N Engl J Med. 2011;364(22):2138-46.
3. World Health Organization [Internet]. Global burden of stroke [Citado 2016 Dic 18]. Disponible en: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf?ua=1].
4. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355-69.
5. Feigin VL, Mensah GA, Norrving B, Murray CJ, Roth GA. Atlas of the Global Burden of Stroke (1990-2013): The GBD 2013 Study. Neuroepidemiology. 2015;45(3):230-6.
6. Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 2009;8(4):345-54.
7. Saposnik G, Cote R, Phillips S, Gubitz G, Bayer N, Minuk J, et al. Stroke outcome in those over 80: a multicenter cohort study across Canada. Stroke. 2008;39(8):2310-7.
8. DANE [internet]. Population and Demography - Projected Populations. [Citado 2017 Ene 30]. Available from: http://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-ypoblacion/proyecciones-de-poblacion.
9. Van der Worp HB, van Gijn J. Clinical practice. Acute ischemic stroke. N Engl J Med. 2007;357(6):572-9.
10. Lo EH, Dalkara T, Moskowitz MA. Mechanisms, challenges and opportunities in stroke. Nat Rev Neurosci. 2003;4(5):399-415.
11. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6(2):182-7.
12. Del Zoppo GJ. Plasminogen activators and ischemic stroke: conditions for acute delivery. Semin Thromb Hemost. 2013;39(4):406-25.
13. The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group. Tissue Plasminogen Activator for Acute Ischemic Stroke. New Engl J Med. 1995;333(24):1581-8.
14. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Thrombolysis with Alteplase 3 to 4.5 hours after Acute Ischemic Stroke. N Engl J Med. 2008;359(13):1317-29.
15. Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.
16. Coutts SB, Wein TH, Lindsay MP, Buck B, Cote R, Ellis P, et al; Heart, and Stroke Foundation Canada Canadian Stroke Best Practices Advisory Committee. Canadian Stroke Best Practice Recommendations: secondary prevention of stroke guidelines, update 2014. Int J Stroke. 2015;10(3):282-91.
17. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al; American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641.
18. European Stroke Organisation. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457-507.
19. Lindsay P, Bayley M, Hellings C, Hill M, Woodbury E, Phillips S. Canadian best practice recommendations for stroke care (updated 2008). CMAJ. 2008;179(12 Suppl):S1-25.
20. Colombian General Social Security System for Health. Clinical Practice Guideline for diagnosis, treatment and rehabilitation of Acute Ischemic Stroke in population over the age of 18. 2015.
21. Adams HJ, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41.
22. Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in StrokeMonitoring Study (SITS-MOST): an observational study. Lancet. 2007;369(9558):275-82.
23. Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA. Gender Differences in Stroke Incidence and Poststroke Disability in the Framingham Heart Study. Stroke. 2009;40(4):1032-7.
24. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke: Results From a Population-based Study. Stroke. 2005;36(6):1115-9.
25. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545-88.
26. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and metaanalysis. Lancet. 2012;379(9834):2364-72.
27. van Oostenbrugge RJ, Hupperts RM, Lodder J. Thrombolysis for acute stroke with special emphasis on the very old: experience from a single Dutch centre. J Neurol Neurosurg Psychiatry. 2006;77(3):375-7.
28. Tanne D, Gorman MJ, Bates VE, Kasner SE, Scott P, Verro P, et al. Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older : the tPA stroke survey experience. Stroke. 2000;31(2):370-5.
29. Uyttenboogaart M, Schrijvers EM, Vroomen PC, De Keyser J, Luijckx GJ. Routine thrombolysis with intravenous tissue plasminogen activator in acute ischaemic stroke patients aged 80 years or older: a single centre experience. Age and ageing. 2007;36(5):577-9.
30. Boulouis G, Dumont F, Cordonnier C, Bodenant M, Leys D, Henon H. Intravenous thrombolysis for acute cerebral ischaemia in old stroke patients >/= 80 years of age. J Neurol. 2012;259(7):1461-7.
31. Gomez-Choco M, Obach V, Urra X, Amaro S, Cervera A, Vargas M, et al. The response to IV rt-PA in very old stroke patients. Eur J Neurol. 2008;15(3):253-6.
32. Toni D, Lorenzano S, Agnelli G, Guidetti D, Orlandi G, Semplicini A, et al. Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy. Cerebrovasc Dis. 2008;25(1-2):129-35.
33. Berrouschot J, Rother J, Glahn J, Kucinski T, Fiehler J, Thomalla G. Outcome and severe hemorrhagic complications of intravenous thrombolysis with tissue plasminogen activator in very old (> or =80 years) stroke patients. Stroke. 2005;36(11):2421-5.
34. Chen CI, Iguchi Y, Grotta JC, Garami Z, Uchino K, Shaltoni H, et al. Intravenous TPA for very old stroke patients. Eur Neurol. 2005;54(3):140-4.
35. Ringleb PA, Schwark C, Kohrmann M, Kulkens S, Juttler E, Hacke W, et al. Thrombolytic therapy for acute ischaemic stroke in octogenarians: selection by magnetic resonance imaging improves safety but does not improve outcome. J Neurol Neurosurg Psychiatry. 2007;78(7):690-3.
36. Sylaja PN, Cote R, Buchan AM, Hill MD. Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study. J Neurol Neurosurg Psychiatry. 2006;77(7):826-9.
37. Meseguer E, Labreuche J, Olivot JM, Abboud H, Lavallee PC, Simon O, et al. Determinants of outcome and safety of intravenous rt-PA therapy in the very old: a clinical registry study and systematic review. Age Ageing. 2008;37(1):107-11.
38. Mouradian MS, Senthilselvan A, Jickling G, McCombe JA, Emery DJ, Dean N, et al. Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients. J Neurol Neurosurg Psychiatry. 2005;76(9):1234-7.
39. Saposnik G, Baibergenova A, O’Donnell M, Hill MD, Kapral MK, Hachinski V, et al. Hospital volume and stroke outcome: Does it matter?. Neurology. 2007;69(11):1142-51.
40. Castañeda Cardona C, Coral Casas J, Rueda MC, Díaz Cortés D, Ruíz A. Experience with intravenous thrombolysis for stroke in the Hospital Universitario San Ignacio 2011-2013 (EXTRO HUSI). Acta Neurol Colomb. 2014;30(1):16-21.
41. Tosta ED, Rebello LC, Almeida SS, Neiva MS. Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil. Arq Neuropsiquiatr. 2014;72(5):368-72.
42. Cabral NL, Conforto A, Magalhaes PS, Longo AL, Moro CH, Appel H, et al. Intravenous rtPA versus mechanical thrombectomy in acute ischemic stroke: A historical cohort in Joinville, Brazil. eNeurologicalSci. 2016;5:1-6.
43. Arora R, Salamon E, Katz JM, Cox M, Saver JL, Bhatt DL, et al. Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age. Stroke. 2016;47:2347-54.
44. Adeoye O, Hornung R, Khatri P, Kleindorfer D. Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years. Stroke. 2011;42(7):1952-5.
45. Heo JH, Kim YD, Nam HS, Hong K-s, Ahn SH, Cho HJ, et al. A Computerized In-Hospital Alert System for Thrombolysis in Acute Stroke. Stroke. 2010;41:1978-83.
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